The federal government, functioning as the nation’s largest insurer, moves the needle on change. The government is getting away from fee-for-service ­­— where every doctor and hospital who touch a patient during a procedure bills the government and gets paid, a system that rewards quantity, not quality — to a value-based system. And as Medicare does, so does commercial health insurance. Aetna, for example, now no longer will pay for a second surgery if the first one is screwed up: Instead, doctors and hospitals eat the cost. Aetna is paying for value, not volume, which experts agree is good for the health care system.

John H. O’Donnell, president of Insurance Consultants of Central Florida, said he could see accountable care organizations resulting in a 10 percent to 20 percent drop in insurance costs for businesses, if successful. “I’m very optimistic.”

Dennis Buhring, CEO of Altamonte Springs-based Physician Associates LLC, which also has talked about forming an ACO, thinks the eventual impact will be reduced costs. “Will we see a huge reduction in year one? Probably not. But if we start to control chronic disease, I think the cost curve down the road will be lower. We’re on the cusp. It’s a journey.”

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